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Should State Wait and See on Health Exchange?

Sen. Aaron Bean might have summed it up best Tuesday as he and other lawmakers listened to a discussion of the Affordable Care Act between an official of the libertarian Cato Institute and an architect of Massachusetts' health-care overhaul.

"It's just as good as the Hannity show, with the back and forth,'' said Bean, drawing laughs as he referred to the sometimes-combative Fox News show featuring conservative commentator Sean Hannity.

But while Michael Cannon, director of health policy studies at the Cato Institute, and Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology, agreed on little about the federal health law, one bit of common ground emerged: Florida should go slow in its approach to a health-insurance exchange.

Lawmakers this spring likely will decide whether the state wants to take part in running an exchange -- and, if so, how to do it. Under the federal health law, better known as Obamacare, each state will have such an exchange to act as a sort of online market where people will be able to shop for insurance coverage. Depending on income levels, many people will be eligible for subsidies to buy insurance through the exchange.

Florida has already missed a deadline that officials have said virtually assures the federal government will run Florida's exchange when it takes effect in January 2014. But Florida could decide to run the exchange in the future or enter into a partnership with the federal government.

Gruber, who helped craft the Massachusetts law that was a model for the Affordable Care Act and also served as a consultant to the Obama administration, told a Senate select committee Tuesday that the best approach would be for Florida to let the federal government establish the exchange but enter a partnership in which the state could help determine the insurance choices available to residents. He said the state's role doesn't have to be "all or nothing."

"Let the federal government do the heavy lifting, let them do the programming, let them do the incredibly hard work, but don't abdicate your responsibility to your citizens to make sure they're getting the best choices and to evaluate the choices that are made, to study that and learn over time,'' Gruber said.

Cannon said he thinks the state should refuse to create an exchange. But he said even if lawmakers are interested in running an exchange, they should hold off on making a decision about the issue. He said state officials will get the blame if an exchange leads to such things as higher insurance premiums.

"There's nothing in here for you but headache,'' Cannon said. "But look, if you disagree, then I think the safest thing is to just take a wait-and-see approach. Maybe wait a year, maybe wait two years. Let the federal government operate the exchange."

Senate President Don Gaetz, R-Niceville, formed the select committee to study the Affordable Care Act and come up with proposals about how to move forward with issues such as the health-insurance exchange and a potential expansion of Medicaid eligibility. Committee Chairman Joe Negron, R-Stuart, said he expects recommendations shortly before the annual legislative session starts in March or during the first week of the session.

During Tuesday's meeting, Cannon and Gruber offered vastly different views about issues such as the Medicaid expansion. Gruber said, in part, the expansion would help save lives of low-income people, while Cannon pointed to billions of dollars in additional costs for the federal and state governments.

The widely different views were also evident as Bean, who is chairman of the Senate Health Policy Committee, questioned the possibility of the state running an exchange. He said the exchange would be governed by federal regulations, which could change.

"Why on earth would Florida want to run an exchange when it's just the federal government telling us what to do with very, very little flexibility?'' asked Bean, R-Fernandina Beach.

"Why on earth would you want to let the federal government do it for you?" Gruber responded. "You're basically, essentially saying, 'We, for political reasons, want to abdicate this role (and) let the federal government do it for us.' And why would you do that?"